Well Implemented, President Obama's National HIV/AIDS Strategy Is Precisely What Is Needed to Further Control HIV/AIDS

During the 2008 campaign, a coalition of AIDS service organizations and advocates called upon all candidates for the Presidency to develop a National HIV/AIDS Strategy to address serious gaps in progress against HIV/AIDS. As a candidate, the future President Obama pledged that his administration would develop a Strategy and, since his election, the White House has actively solicited advice from people living with HIV and community groups on what should be contained in the Strategy. Project Inform has served as a member of the Steering Committee of the Coalition for a National AIDS Strategy and has provided significant advice as to what we believe this much needed document should contain.

In December 2009, Project Inform and the Community HIV/AIDS Mobilization Project co-hosted a meeting of leading HIV experts who recommended that the Strategy include an initiative called Testing & Linkage to Care Plus (TLC+). TLC+ proposes that by greatly increasing HIV testing nationally and quickly linking newly diagnosed HIV-positive people to primary medical care, social services, prevention counseling, plus treatment, the U.S. could greatly increase the percentage of HIV-positive people adhering to care and treatment, improve their heath outcomes, prevent new infections, and reduce health disparities suffered by women and people of color.

On July 13, President Barack Obama released the National HIV/AIDS Strategy and warmly welcomed HIV advocates to a White House reception to mark this important development in the epidemic. Project Inform was honored to be in attendance at that historic event. The Strategy was prepared in close coordination between the President's Office of National AIDS Policy (ONAP) and an Inter-Agency Work Group made up representatives of all Federal agencies involved in the nation's response to HIV/AIDS. It was reviewed before being released by the President's Advisory Committee on HIV/AIDS (PACHA), which includes people living with HIV and representatives of AIDS service organizations.

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The Strategy is almost entirely what Project Inform hoped for. It sets assertive but achievable goals for improving the health of HIV-positive people and reducing new infections. It is deliberately and thoughtfully focused on a limited set of goals and activities that are most likely to have significant impact on the epidemic. ONAP, the Inter-Agency Work Group and PACHA deserve enormous credit both for the plan itself and the inclusive process used to develop it. Project Inform's summary of the Strategy can be seen here. President Obama's remarks about its release are available at AIDS.gov.

First and foremost, the Strategy takes a well-reasoned and thoughtful public health approach previously missing in the epidemic. HIV treatment has historically been focused on improving the health of the individual, as well it should be. However, just as TLC+ does, the Strategy is focused on making certain that more HIV-positive people know their status and are linked quickly to care and social services that will prepare them to take HIV medications early in infection and remain adherent to treatment. It asserts that doing so will help to meet the important goals of increasing the percentage of HIV-positive individuals engaged in care and treatment that prolongs and improves quality of life, as well as reducing new HIV infections. The Strategy also makes clear that effective HIV prevention requires combining different proven methods, including promotion of condoms, availability of sterile syringes for injection drug users and supporting HIV-positive people to avoid transmitting the virus to others.

With regard to prevention, the Strategy courageously promotes two additional actions. First, it asserts that the focus of prevention programs and funding should be on those geographic areas and risk groups that are actually suffering the greatest burden of new infections. Those include urban areas and gay and bisexual men, particularly gay and bisexual men of color, transgenders and injections drug users. It notes that most, though certainly not all, HIV cases among people of color occur in gay and bisexual men. Second, the Strategy supports the development of prevention interventions that are likely to have community-wide impact, not just individual impact.

While both the HIV care and prevention provisions of the Strategy have a decidedly medical focus, the document correctly asserts that successfully engaging HIV-positive people in care and treatment, as well as preventing HIV, requires an increased focus on the enormous needs of people living with and at high risk for HIV for basic social services including housing, mental health and substance abuse treatment. It also asserts the importance of reducing stigma and discrimination against people with and at risk for HIV -- including among medical providers -- in order to increase chances that individuals will obtain HIV testing, medical care and treatment.

Importantly, the Strategy contains a discussion about the need for much greater coordination of the work of Federal agencies involved in the nation's response to HIV/AIDS, and for improved coordination and streamlining of programs among Federal, State and local government agencies. The President has directed the Office of the Assistant Secretary of Health & Human Services (HHS) to coordinate the efforts not just of the many agencies involved in HIV/AIDS within HHS, but of all Federal agencies.

This article was provided by Project Inform. It is a part of the publication Project Inform Perspective. Visit Project Inform's website to find out more about their activities, publications and services.

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